Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Book Review
Case Report
Case Series
Clinical Article
Clinical Innovation
Clinical Pearl
Clinical Pearls
Clinical Showcase
Clinical Technique
Critical Review
Editorial
Expert Corner
Experts Corner
Featured Case Report
Guest Editorial
Letter to Editor
Media and News
Original Article
Original Research
Research Gallery
Review Article
Special Article
Special Feature
Systematic Review
The Experts Corner
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Book Review
Case Report
Case Series
Clinical Article
Clinical Innovation
Clinical Pearl
Clinical Pearls
Clinical Showcase
Clinical Technique
Critical Review
Editorial
Expert Corner
Experts Corner
Featured Case Report
Guest Editorial
Letter to Editor
Media and News
Original Article
Original Research
Research Gallery
Review Article
Special Article
Special Feature
Systematic Review
The Experts Corner
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Book Review
Case Report
Case Series
Clinical Article
Clinical Innovation
Clinical Pearl
Clinical Pearls
Clinical Showcase
Clinical Technique
Critical Review
Editorial
Expert Corner
Experts Corner
Featured Case Report
Guest Editorial
Letter to Editor
Media and News
Original Article
Original Research
Research Gallery
Review Article
Special Article
Special Feature
Systematic Review
The Experts Corner
View/Download PDF

Translate this page into:

Clinical Pearl
13 (
3
); 193-195
doi:
10.25259/APOS_7_2023

Palatal skeletal anchorage: multiple applications with a single appliance

Department of Orthodontics, University of Ferrara, Ferrara, Italy
Corresponding author: Giulia Romagnolo, Department of Orthodontics, University of Ferrara, Ferrara, Italy. giulia01.romagnolo@edu.unife.it
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Palone M, Romagnolo G, Cremonini F, Paoletto E, Lombardo L. Palatal skeletal anchorage: multiple applications with a single appliance. APOS Trends Orthod 2023;13:193-5.

Abstract

Using a single bone-borne maxillary appliance with twofold mechanics, that is, rapid palatal expander and nonfrictional distalizing appliance (Pendulum) is a valuable option to treat young-adult patients with poor compliance. In this particular case, the same appliance was used to disinclude 2.3, eliminating reaction forces on the arch. Therefore, the first expansive phase was followed by the distalizing phase. After enough space was obtained for the recovery of tooth 2.3, a triple-looped titanium-molybdenum alloy (TMA) spring was used to perform canine orthodontic traction. The core concept is that digital planning and optimal positioning of two palatal mini-screws can ensure a bicortical anchorage which, in turn, enabled to tolerate the different orthodontic phases. As a matter of fact, a tooth-bone-borne anchorage was followed by a pure bone-borne anchorage with no lost of stability.

Keywords

Miniscrew
Pendulum
RPE
Rapid palatal expansion
Surgical assisted eruption

Palatal vault is considered an election site for mini-screws placement, due to its availability, the presence of high-quality bone, and the absence of nerves and blood vessels, which makes the zone safe and suitable for many clinical applications.[1]

As a matter of fact, palatal mini-screws could be effective for Class II malocclusion in young-adult patients to achieve both adequate transverse maxillary expansion (with both hybrid or bone-borne anchorage) and distalization of upper molars, avoiding or minimizing some common side effects of these procedures, such as vestibular tipping of molars, mesialization of premolars, and flaring of incisors.[2]

This case shows how a hybrid T-Rex rapid palatal expander (RPE) could be an efficient option to achieve both transverse maxillary expansion and upper molar distalization, thus avoiding multiple appliances and waste of time. Moreover, it was applied for the recovery of maxillary canine too, without the undesired intrusion of contiguous teeth and the occurrence of anterior open bite. Furthermore, these mechanics were accomplished without asking for the patient’s compliance.

To fulfill all these objectives, a bicortical engagement of palatal mini-screws was ensured by MAPA protocol.[3]

A 14-year-old Caucasian female patient presented a Class II malocclusion with skeletal maxillary constriction and inclusion of tooth 2.3. The total lack of space for its eruption was evident, with the upper dental midline shifted completely toward the second quadrant, whereas posterior teeth shifted mesially establishing a full cusp Class II molar relationship [Figure 1].

Figure 1:
Initial intraoral photographs.

Conventional orthodontic treatment alternatives would implicate an RPE, headgear extraoral appliance (to avoid premolars mesial shifting), and the recovery of the 2.3 with fixed appliances (FAs).[4] Through digital planning [Figure 2], hybrid T-rex RPE was designed to perform all these biomechanics [Figure 3]. After the first phase of expansion (30 turns) [Figures 4 and 5] and 2 months of stabilization, TMA springs were inserted to perform upper molar distalization. After 9 months of repeated activations, a bilateral Class I molar relationship was achieved and the space for 2.3 recovered, together with the use of FAs [Figure 6]. After the surgical exposition, an extrusive force for 2.3 recovery was applied with a triple-looped 0.036-inch blue-Elgiloy spring [Figures 7 and 8] until also bilateral Class I canine relationship was obtained [Figure 9].

Figure 2:
Initial x-rays and digital planning on cone-beam computed tomography system.
Figure 3:
Hybrid T-rex rapid palatal expander appliance.
Figure 4:
Bonded hybrid rapid palatal expander appliance.
Figure 5:
Rate of expansion after 30 turns.
Figure 6:
Insertion of TMA springs after removing expander arms and open coil inserted in fixed appliance.
Figure 7:
2.3 Eruption and engagement with triple-looped TMA spring.
Figure 8:
2.3 successfully aligned and engaged in the 0.019 × 0.025 SS archwire.
Figure 9:
Final intraoral photographs.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest

There are no conflicts of interest.

Financial support and sponsorship

Nil.

References

  1. , , , , . The T-zone: Median vs. paramedian insertion of palatal mini-implants. J Clin Orthod. 2016;50:543-51.
    [Google Scholar]
  2. , , , , , . Class II subdivision with skeletal transverse maxillary deficit treated by single-sitting bone-borne appliance: A case report. Angle Orthod. 2021;91:129-37.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , . MAPA: A new high-precision 3D method of palatal miniscrew placement. Eur J Clin Orthod. 2015;3:41-7.
    [Google Scholar]
  4. , . Very early orthodontic treatment: When, why and how? Dental Press. J Orthod. 2022;27:2.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
18,431

PDF downloads
916
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections